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Pediatric complicated appendicitis: Results of a standardized antibiotic protocol in a tertiary center

Estelle Studer1, Carla Flament-Viricel1, Ana M Calinescu2

  • 1Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.

Journal of Pediatric Surgery
|December 10, 2025
PubMed

Insights

One in seven children with complicated appendicitis required an antibiotic switch. High CRP and abscesses predict the need for Piperacillin/Tazobactam (PT) over Ceftriaxone/Metronidazole (CM).

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Standard treatment for pediatric complicated appendicitis (CA) involves appendectomy and intravenous antibiotics.
  • Ceftriaxone/Metronidazole (CM) is the recommended first-line antibiotic, with a switch to Piperacillin/Tazobactam (PT) advised if fever persists postoperatively.
  • Fever is the sole current criterion for antibiotic regimen adjustment.

Purpose of the Study:

  • To identify predictors for switching from CM to PT in children with CA.
  • To assess the potential benefit of using PT as an upfront first-line treatment to reduce hospital stay.

Main Methods:

  • Retrospective analysis of 256 children (0-16 years) treated for CA between 2013 and 2023.
  • Comparison of patients who required an antibiotic switch versus those who did not.
  • Analysis included demographics, medical history, biomarkers, imaging, and surgical findings.

Main Results:

  • 15% (39 out of 256) of patients required a switch in antibiotic treatment.
  • Multivariate logistic regression identified high preoperative C-reactive protein (CRP) levels (p=0.021) and intra-abdominal abscess (p<0.001) as significant predictors for switching.
  • No other variables showed significant association with the need for antibiotic switch.

Conclusions:

  • Approximately 15% of pediatric CA cases necessitate a switch from CM to PT.
  • Elevated preoperative CRP and the presence of an intra-abdominal abscess are key indicators for requiring PT.
  • These findings suggest that children with these indicators may benefit from initial PT treatment.
Abstract

Keywords:
Antibiotic therapyChildrenComplicated appendicitisEffectivenessSurgery

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